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General NPI Number Information
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NPI Number | 1831139377
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Entity Type | Individual
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Provider Name | LISA LLANAS HAGBERG MD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 600 COASTAL VILLAGE DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-1973
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Country | US
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Telephone | 912-554-8454
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 FREDERICA RD APT 222
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-2551
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Country | US
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Telephone | 508-971-6500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 158615
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 104720
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License Number State | GA
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